Individual
DR. RAFAEL ROBERTO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3347 STATE ROAD 7, SUITE 101, WELLINGTON, FL 33449-8095
(561) 790-2111
(561) 790-0893
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME58240
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064063800
—
FL
01
—
1004922
CAREPLUS
FL
01
—
11453
BCBS
FL
01
—
1249241
WELLCARE
FL
01
—
4200237
AETNA
FL
01
—
7851
DIMENSION HEALTH
FL
01
—
P01606329
RR MEDICARE
FL
Enumeration date
01/06/2006
Last updated
11/15/2016
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